Polycystic Ovarian Syndrome
Polycystic ovarian syndrome, better known as PCOS, is the most common endocrine disorder in women of reproductive age and is thought to affect five to ten percent of all U.S. women. Higher percentages are found in African-American females (8%) and Latinas (13%) than among Caucasians (4.8%).
Some of its major clinical symptoms include:
- Menstrual dysfunction
- Oligomenorrhea or amenorrhea (scanty or absent menstruation)
- Anovulation (absence of ovulation)
- Excessive hair growth, also known as hirsutism
- Hair loss (alopecia)
Biochemically, women will have increased production of both estrogen and the male hormone androgen. Additionally, insulin resistance is a biochemical feature of PCOS
Because many of these symptoms and biochemical features also are found in women without PCOS, physicians consider patients to have PCOS when two out of three of these factors are present:
- Oligomenorrhea and/or annovulation (absence of ovulation)
- Hyperandrogenism (excessive secretion of the male hormone androgen that can result in increased growth of body hair); and/or
- Polycystic ovaries.
Females with PCOS have a significantly increased risk for developing cardiovascular disease, endometrial cancer or diabetes. Obesity is a common symptom with 50% of PCOS sufferers being overweight. Ten percent of PCOS patients have Type 2 diabetes. Genetic predisposition, aging, pregnancy, drugs or lifestyle increase the risk of insulin resistance that in turn increases the risk of PCOS with symptoms of acne, hirsutism, hyperandrogenism, and infertility.
There are interactive Web-based programs that patients can access for support including PCOS Success for exercise and nutritional coaching and PCOS Support for education and community support.
When a PCOS sufferer becomes pregnant, complications such as spontaneous abortions, impaired glucose tolerance, gestational diabetes, hypertension and small gestational age can incur.
Infertility and PCOS
Greater than 75% of women with anovulation, a common PCOS symptom, experience infertility. PCOS affects follicular arrest and the impaired selection of the dominant follicle.
Treatment and Resolution
Small to moderate weight loss will restore menstrual cycles and help PCOS sufferers ovulate to eventually achieve pregnancy. Weight loss also helps to decrease insulin resistance and moderates other health risks, making it easier to achieve pregnancy. Doctors usually recommend lifestyle modification with proper nutrition and increased exercise to achieve the ideal BMI (body mass index).
If a patient is insulin resistant, three types of medication are recommended:
Fertility Treatment for PCOS Patients
In addition to treating PCOS sufferers with ovulation induction and in vitro fertilization, doctors may also recommend in vitro maturation, where immature eggs (oocytes) are retrieved from the ovary and matured in the laboratory for 24-48 hours. Then fertilization takes place and the resulting embryos are transferred to the uterus.